Neuro-urology is a sub-specialty of Urology that focuses on neurogenic bladder, a condition that encompasses disorders of the bladder, lower urinary tract and the pelvic floor in relation to spinal injuries and neurological disorders. Additionally, neuro-urology treats and manages diseases and functional disorders of the lower urinary tract and the sexual organs after damage of the associated innervation and control.
Conditions Managed Through Neuro-urology
The main focus of neuro-urology is the diagnosis, treatment and management of conditions such as:
- Functional disorder of the urinary bladder
- Functional disorder of the sphincter
- Erectile dysfunction
- Ejaculatory disorders
- Defecation disorders
The control of the lower urinary tract, which includes the urinary bladder, urethra, and muscular urinary sphincters, is complicated making it susceptible to malfunction. As a result, functional disturbances of the lower urinary tract affect many individuals with neurological disorders, traumas, or anomalies such as spinal cord injury, multiple sclerosis, stroke, Parkinson’s Disease, and spina bifida.
The nerves that detect bladder fullness are essential for normal bladder function. These emotions are disrupted by nerve diseases, resulting in abnormal bladder function, or a neurogenic bladder.
These conditions require intact nervous signal conduction and modulation at the peripheral level through pelvic nerves as well as in neuronal centres in the spinal cord and brain, which is achieved through neuro-urology.
Diagnosis of Neurogenic Bladder
To make a definitive diagnosis of a neurogenic bladder, the urologist will check the patient’s medical history and perform a physical exam to determine if the patient has a neurogenic bladder.
During the diagnosis process, different tests are used which include a urine flow test or pressure flow rate cytometry. A cystoscope can be used to check the anatomy inside the bladder, and another test monitors fluid intake and urinary output, often utilising a catheter to empty the bladder. A kidney ultrasound may also be recommended, as well as video urodynamic studies.
Depending on the type of neurogenic disorder the patient has, the urologist may recommend one or more diagnostic procedures based on the information gathered to build an appropriate treatment plan.
Symptoms of Neurogenic Bladder
Some of the common symptoms of neurogenic bladder include:
- The need to urinate frequently and urgently
- Frequent urination during night.
- Uncontrolled loss of urine (incontinence)
- Pain while urinating
- Inability to empty the bladder completely
- Bladder infections, which can be complicated by infections that spread to the renal pelvis and kidneys
Causes of Neurogenic Bladder
Neurogenic bladder is caused by a brain or spinal cord injury or disease that disrupts nerve conduction in the pelvic area, resulting in bladder sensation and control loss. These conditions include:
- Brain or spinal cord tumours
- Spinal injuries
- Chronic neurological disorders
- Genetic nerve problem
- Birth defects that affect the spinal cord
- Infections of the spinal cord
- Accidents especially those that may cause injury to the brain or spinal cord
Treatment of Neurogenic Bladder
Treatment of neurogenic bladder is mostly determined by the diagnosis and severity of the condition. Catheterization, medicines, hydration control, and even exercise may be used to manage the condition and drastically improve the patient’s quality of life.
Incontinence caused by a neurological system conditions like Parkinson’s disease, multiple sclerosis, cerebral palsy may be treated with an anticholinergic medicine. These drugs help to relax the muscles of the bladder. However, in extreme cases, urine diversion, which includes rerouting the urinary system, may be required.
How to Maintain and Improve Quality of Life for Neurogenic Patients
For those with neurological disorders, maintaining a natural bladder function is critical. The goal of diagnostic and treatment approaches is to prevent subsequent bladder and kidney damage, maintain urine continence in daily life, and improve sexual functions. As a result, the patient’s quality of life can significantly improve.
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